Suicidal Behaviour

Underlying dynamics

Updesh Kumar, Updesh Kumar

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317643388
• Edition: 1
• Topic: Psicologia
• Subtopic: Salute mentale in psicologia

Suicidal Behaviour: Underlying dynamics is a wide ranging collection of articles that builds upon an earlier volume by the same editor ( Suicidal Behaviour: Assessment of people-at-risk, 2010) and delves deeper into the dynamics of suicide by synthesizing significant psychological and interdisciplinary perspectives. The volume brings together varied conceptualizations by scholars across disciplines from around the globe, thereby adding on to the available theoretical understandings as well as providing research based inputs for practitioners in the field of suicidal behaviour.

This book contains sixteen chapters divided into two broad sections. The volume opens with a discussion about the Theoretical Underpinnings of suicidal behaviour spread through the initial eight chapters that conceptualize the phenomenon from different vantage points of genetics, personality theory, cognitive and affective processes, stress and assessment theories. The second section brings in the Varied Research Evidences and Assessment Perspectives from different populations and groups. Building upon the theoretical foundations the chapters in this section discuss the nuances of dealing with suicidal behaviours among sexual minority populations, alcoholics, military personnel, and within in specific socio-cultural groups. The section closes with an intense focus on a significant issue encountered often in clinical practice, that of assessment of suicide risk, and ways of resolving the cultural, ethical and legal dilemmas.

Part I

Theoretical underpinnings

1 Conceptualizing suicidal behaviour

Understanding and prevention

Hardeep Lal Joshi, Vijay Parkash and Updesh Kumar

Suicide is one of the major causes of death among people in the West and now the suicidal cases are rising in the Eastern countries as well (World Health Organization (WHO), 2012). WHO (1999) has estimated that approximately 1.53 million people will die from suicide, and ten to twenty times more people will attempt suicide across the world by the year 2020. These estimates indicate that on average one death will occur every 20 seconds and one attempt will be carried out every one to two seconds. Although of low predictive value, in these estimates the presence of psychopathology is perhaps the single most important predictor of suicide (Gvion and Apter, 2012).

According to another WHO estimate, every year about 170,000 deaths by suicide occur in India (as cited by Patel et al., 2012). As per a decade-old estimate, every year, of the half million people dying by suicide across the world, 20 per cent were Indians (Singh and Singh, 2003) of the 17 per cent of the world population. In the past two decades the suicide rate has escalated from below 8 to above 10 per 100,000 (Vijayakumar, 2007). In a recent study published in the Lancet in June 2012, it was estimated that about 187,000 suicides occurred in 2010 (Patel et al., 2012). These estimates show that suicide is fast becoming a menace to human life and therefore it calls for urgent action that can lead to finding ways to curb this growing tendency among people.

The aftermaths of suicide are often massive because not only does it annihilate a person’s existence but also leaves his family and friends in the lurch, thrusting upon them emotional, mental and physical stress. A person who attempts suicide, essentially, needs medical help and treatment and therefore it is necessary to broaden the knowledge regarding suicide and carry out extensive research in this field.

Ancient understanding

Strikingly, in ancient times, the act of suicide was not considered disagreeable and was instead regarded as a good method to avoid life’s frustrating circumstances. Ancient Romans before the fourth century deemed the quality of life to be of greater value than its longevity. Seneca, the first- century Roman philosopher, acknowledged suicide as a decent way to end life’s misery. Even the Christian Church began denouncing suicide as sinful only in the fourth century which then proclaimed that the act of suicide is in violation of the Sixth Commandment – Thou shalt not kill – and therefore began viewing it as a crime. Later on, the Italian philosopher St Thomas Aquinas, in the thirteenth century, declared that suicide is a mortal sin because it invades God’s power over human life. Since suicide began to be considered a crime against God, in Christianity, for a long time people committing suicide were debarred from burial in a Christian graveyard. It is interesting to note that suicide continued to be a criminal offence in the United Kingdom until 1961, where Christianity is the major religion.

Like the European countries, the concept of suicide was grappled with by Asian countries as well. From 1200 to the 1600s, suicide – hara-kiri in Japanese – was viewed as a dignified means of departing from life’s disgraceful state of affairs. In ancient India too, suicide was preferred as a better option to death from disease. Considering the Confucianist views, the act of suicide is not condemnable. In Confucian opinion, the act of suicide is seen in relation to the events that lead up to it, and can therefore, depending on the circumstances, be seen as something honourable or dishonourable. In China, where Confucianism is followed widely, suicide is also seen as a passionate protection of one’s honour or integrity and as a spirited resistance against something bad. In Confucian cultural tradition, suicide in general is seen as something negative but it can sometimes be justified if it is for a noble purpose. ‘Confucius would see suicide as an option for protecting one’s virtue and integrity, but that more can be gained by doing well in life instead of killing oneself’ (Van Tuan, 2010, p. 5).

From the Buddhist point of view, it is a common belief that life is a transitory abode while death would be a long-lasting subsistence. However, in Buddhism, it is believed that the next life depends on the way one lives one’s present life and suicide is condemned because running away from this life by means of ‘death’ cannot prevent the anxieties of the next life. It shows that Buddhist beliefs are close to the existential model of thinking (Van Tuan, 2010, p. 5). Similarly in Islamic countries, suicide is regarded as an unholy act because the Quran, the religious text of Islam, considers it to be one of the most horrible sins that obstructs man’s spiritual path. This is one of the reasons why in most Muslim countries suicide is still considered as a crime. Although some countries do consider suicide a crime, individual suicide has been decriminalized in the Western world. In the United States of America, it is not illegal to commit suicide but the person can be penalized for an attempt. It is interesting to note that at present, no European country considers attempted suicide a crime (McLaughlin, 2007), whereas, in India, attempted suicide is a punishable offence.

Conceptualizing suicide

Many psychologists regard suicidal ideation as a form of mental illness and suicide as an outcome of this illness and, therefore, an extensive body of work has been done to study the various aspects and dimensions of suicide and suicidal behaviour. Sigmund Freud (1917) in his essay, ‘Mourning and Melancholy’, postulated that the life-instinct ‘Eros’ and the death-instinct ‘Thanatos’ are the two instincts that drive individuals. Researchers believe that Freud’s conceptualization of the

‘death instinct behaviors reflecting self-destructive tendencies, guilt feelings, suicide, melancholia, masochism and sadism are furnished with a motivational force of their own, as well as with a specific mechanism of action, that is the repetition compulsion. The death instinct drives man to the ultimate state of quiescence – death through the urge inherent in organic life to restore an earlier state of things’

(Orbach, 2007, pp. 266, 267)

Freud used to believe that these self-destructive processes lead to depression and suicide. He further posited that most individuals struggle between the two instincts and suicide results when Thanatos wins over Eros. Although there have been many scholars who have contributed enormously to the field of suicidal behaviour research, major work in the conception of suicide was carried out by American psychologist Edwin S. Shneidman in the 1950s. Around six decades ago he co-founded the Los Angeles Suicide Prevention Center in 1958, for the better understanding of suicide. Shneidman neologized various terms like psychache, suicidology, psychological autopsy and postvention. As Shneidman pioneered the research in this field he is often referred to as the father of contemporary suicidology (Leenaars, 2010; Shneidman, 1993).

Derived from the Latin words ‘sui’ (of oneself) and ‘caedere’ (to kill) the word ‘suicide’ was first used in the seventeenth century by Sir Thomas Browne. He introduced this term in his published book Religio Medici in 1643. In 1903 the first ‘International Classification of Diseases and Causes of Death’ was adopted which included ‘suicide’ in the section related to morbidity and mortality due to external factors. Thinkers like Emile Durkheim and Sigmund Freud in their respective studies pointed out the effect of external factors on suicide and therefore led to the encompassing of sociological and psychological aspects in the definition of suicide. But before proceeding to the discussion of the definition of suicide, it is essential to understand that the term ‘suicide’ is often used only for those reported cases where the attempt to kill oneself has resulted in death which apparently makes it quite a restricted term in the sense that it does not cover all the other related aspects of the act. This often leads to flawed estimation of the cases. Therefore, the term ‘suicidal behaviour’ is used to refer to the multidimensional nature of suicide and the acts related to it. Though the nomenclature of suicidal behaviours too has been an issue of international debate among experts as well as there being variations involved in those cases where the attempts do not lead to lethal outcomes, the term ‘suicidal behaviour’ is generally used as a more inclusive term (Silverman et al., 2007a, b; Van Orden et al., 2010).

We all know readily what suicide means whenever it is mentioned in everyday life. But technically, the word suicide does not simply mean ‘killing oneself’. It is a much more complex concept and as mentioned above, the complexity arises from the fact that suicidal behaviour is used to describe a varied gamut of results, one of them being suicide. Basically, three categories of suicidal behaviour have been suggested: completed suicide, suicide attempt, and suicidal ideas (Beck et al., 1972).

It may be noted that not every act of killing oneself can be classed as suicide. In order to be so, it is essential that the person must intentionally initiate the act, in the full knowledge or anticipation of its lethal results. On the other hand, there is much variation among the terms used for suicidal behaviours without lethal results so those acts of terminating one’s own life which have non-fatal results are designated as suicidality, attempted suicide, suicide attempts, act of intentional self-harm or para-suicide (WHO, 1998). The International Classification of Diseases, (ICD-10; WHO, 1992) too has created a separate class of ‘Intentional Self Harm’ stating that it comprises ‘purposely self inflicted poisoning or injury suicide (attempted)’ (p. 1013).

Researchers have contended that there is a continuum from suicidal ideation to gesture to attempt to complete which depicts suicidal behaviour (Crosby et al., 1999; Garland and Zigler, 1993; Silverman and Maris, 1995). Suicidal behaviour generally begins with ideation which includes thoughts about desire and method to commit suicide (Beck et al., 1988). The person here thinks of or wishes to die, this then is reflected in his or her gestures, further transmuting into an attempt and finally might be resulting into completion. Hence it can be said that ‘suicidal behavior is a set of noncontinuous and heterogeneous spectra of behaviors, such that suicidal ideation, suicidal threats, gestures, self-cutting, low lethal suicide attempts, interrupted suicide attempts, near-fatal suicide attempts, and actual suicide’ (Bursztein and Apter, 2009, as cited by Amitai and Apter, 2012, p. 986). Giving a nomenclature to major suicide-related behaviours, O’Carroll et al. (1996) described suicidal ideation as ‘any self-reported thoughts of engaging in suicide-related behavior’; non-suicidal self-injury as ‘direct, deliberate destruction of body tissue without lethal intention’; and a suicide attempt as a ‘potentially self-injurious behavior with a non-fatal outcome, for which there is evidence (explicit or implicit) that the person intended at some level to kill himself/herself’ (cited by Amitai and Apter, 2012, p. 986). These behaviours differ on the scale of rescuability and lethality. In fact, rescuability and fatality are the factors that actually distinguish between suicidal gestures and attempts. Rescuability is high and fatality is low in suicidal gestures or parasuicide where the person concerned does not actually intend to die yet he/she commits the act of self-directed violence. In the absence of the intention to die as in the present context, the term ‘self-harm’ is used. But when there is a presence of intent to die, the rescuability is low and the chances of fatality become high. It may be noted that the applicability of the conceptualization of suicidal behaviour on a continuum for every individual is still to be proved (Silverman and Maris, 1995).

The attributes of lethal suicidal behaviour or suicide are quite different from non-lethal suicidal behaviour. Shneidman (1985) theorized that suicide resulted due to an intense emotional and psychological pain called ‘psychache’, which ultimately becomes unbearable and cannot be abated by previously successful coping patterns. Suicidal death thus, in a sense, is an escape from this pain. This notion of escape from unbearable experiences has also been endorsed by an...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of contributors
• Foreword
• Preface
• Part I Theoretical underpinnings
• Part II Varied research evidence and assessment perspectives
• Index